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Clinical Rheumatology
Published in: Clinical Rheumatology 11/2015

01-11-2015 | Original Article

Vascular perfusion kinetics by contrast-enhanced ultrasound are related to synovial microvascularity in the joints of psoriatic arthritis

Authors: Ugo Fiocco, Roberto Stramare, Alessandro Coran, Enrico Grisan, Elena Scagliori, Francesco Caso, Luisa Costa, Francesca Lunardi, Francesca Oliviero, Fulvia Chieco Bianchi, Anna Scanu, Veronica Martini, Daniele Boso, Valeria Beltrame, Maristella Vezzù, Luisella Cozzi, Raffaele Scarpa, David Sacerdoti, Leonardo Punzi, Andrea Doria, Fiorella Calabrese, Leopoldo Rubaltelli

Published in: Clinical Rheumatology | Issue 11/2015

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Abstract

The purpose of the study was to assess the relationship of the continuous mode contrast-enhanced harmonic ultrasound (CEUS) imaging with the histopathological and immunohistochemical (IHC) quantitative estimation of microvascular proliferation on synovial samples of patients affected by sustained psoriatic arthritis (PsA). A dedicated linear transducer was used in conjunction with a specific continuous mode contrast enhanced harmonic imaging technology with a second-generation sulfur hexafluoride-filled microbubbles C-agent. The examination was carried out within 1 week before arthroscopic biopsies in 32 active joints. Perfusional parameters were analyzed including regional blood flow (RBF); peak (PEAK) of the C-signal intensity, proportional to the regional blood volume (RBV); beta (β) perfusion frequency; slope (S), representing the inclination of the tangent in the origin; and the refilling time (RT), the reverse of beta. Arthroscopic synovial biopsies were targeted in the hypervascularity areas, as in the same knee recesses assessed by CEUS; the synovial cell infiltrate and vascularity (vessel density) was evaluated by IHC staining of CD45 (mononuclear cell) and CD31, CD105 (endothelial cell) markers, measured by computer-assisted morphometric analysis. In the CEUS area examined, the corresponding time-intensity curves demonstrated a slow rise time. Synovial histology showed slight increased layer lining thickness, perivascular lymphomonocyte cell infiltration, and microvascular remodeling, with marked vessel wall thickening with reduction of the vascular lumen. A significant correlation was found between RT and CD31+ as PEAK and CD105+ vessel density; RT was inversely correlated to RBF, PEAK, S, and β. The study demonstrated the association of the CEUS perfusion kinetics with the histopathological quantitative and morphologic estimation of synovial microvascular proliferation, suggesting that a CEUS imaging represents a reliable tool for the estimate of the synovial hypervascularity in PsA.
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Metadata
Title
Vascular perfusion kinetics by contrast-enhanced ultrasound are related to synovial microvascularity in the joints of psoriatic arthritis
Authors
Ugo Fiocco
Roberto Stramare
Alessandro Coran
Enrico Grisan
Elena Scagliori
Francesco Caso
Luisa Costa
Francesca Lunardi
Francesca Oliviero
Fulvia Chieco Bianchi
Anna Scanu
Veronica Martini
Daniele Boso
Valeria Beltrame
Maristella Vezzù
Luisella Cozzi
Raffaele Scarpa
David Sacerdoti
Leonardo Punzi
Andrea Doria
Fiorella Calabrese
Leopoldo Rubaltelli
Publication date
01-11-2015
Publisher
Springer London
Published in
Clinical Rheumatology / Issue 11/2015
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI
https://doi.org/10.1007/s10067-015-2894-1

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